PRIEST [COVID-19] [UPH]
Research type
Research Study
Full title
PAndemic INfluenza Triage in the Emergency Department
IRAS ID
101138
Contact name
Steve Goodacre
Contact email
ISRCTN Number
ISRCTN28342533
Clinicaltrials.gov Identifier
CPMS 12725, ; ,
Research summary
Research Summary
The aim of this study is to find the most accurate triage method (the way of deciding the order of treatment of patients) for predicting severe illness among patients attending the emergency department with suspected respiratory infection (infection in the lungs) during a pandemic (when a disease has spread across many countries). The study will be observational and will not change patient care. Participating hospitals and ambulance trusts will use whatever triage method is most suitable for them, based on national and local guidance. The study will include all adults and children with suspected respiratory infection who attend the emergency department of a participating hospital, call 111 or 999 services or are dealt with by a 999 ambulance from a participating ambulance trust. Outcomes will be assessed based on the triage method used. Patients who die or require respiratory (lung), cardiovascular (heart and blood vessels) or renal (kidney) support will be considered as having an adverse outcome. In addition, if the pandemic leads to hospital resources being overwhelmed, meaning that patients with respiratory, cardiovascular or renal conditions are unable to access support, they will be considered to have had an adverse outcome. If patients survive to 30 days without requiring respiratory, cardiovascular or renal support they will be defined as having no adverse outcome. [COVID-19 amendment 23/03/2020]
Summary of Results
Introduction Hospital Emergency Departments (EDs) have played a crucial role during the COVID-19 pandemic, receiving acutely ill patients, determining the need for hospital admission, and providing treatment. It is very important that EDs are able to assess how likely a person is to become seriously ill, to help make the best decision for a patient’s care and use resources effectively. There are many existing scores available, used as a general guide for ED decision making. The PRIEST study team aimed to develop a COVID-19 specific score.
Methods
Researchers collected information about patients attending EDs around the UK with suspected Covid-19. 30 days after they first attended ED, their medical notes were checked to see whether they had become seriously ill. The study considered a patient seriously ill if they died or required specialist organ support in the 30-day period.Researchers then analysed this data to see which factors, measured at attendance, predicted serious illness. This information was used to develop a severity score.
The study split the patients’ data into two groups, one to create the new score and the other to check that the score was good at predicting who would go on to become seriously ill.Results
A mixture of prospective and retrospective data was collected from 22,445 people who presented to 70 EDs across the UK with suspected Covid-19 infection between March 26, 2020 and May 28, 2020.The severity score
The study adapted a widely existing score called NEWS2. The results from the PRIEST study showed that by adding patient age, sex, and performance status (a rating of ability to function in daily life) to NEWS2, we can better predict the likelihood of a patient becoming seriously ill with Covid-19.
The score ranges from zero to 29 points, with a score above four predicting serious illness. The score has been designed to be usable, and so calculated the score using information normally collected when a patient presents to the ED.
This new severity score was found to be better at predicting serious illness than the CURB-65 and PMEWS, which are pre-existing measures.Conclusion
This new score can be used to support decision-making in hospital EDs, and may help health care professionals make more informed decisions regarding care for those with suspected Covid-19.REC name
North West - Haydock Research Ethics Committee
REC reference
12/NW/0303
Date of REC Opinion
25 Jun 2012
REC opinion
Further Information Favourable Opinion